Breastfeeding Beyond a Year:exploring benefits, cultural influences, and more

I was at the playground last summer with my only son, Jarrett, who turned two in October. He fell on one of the climbing structures and got his first bloody nose. He was very upset (as was I while trying to keep my cool), and I brought him over to the stroller to find some wipes to clean his face. At one point, he looked up at me pleadingly and asked for "bo bo" (the word he uses when he wants to nurse). I looked around and felt uncomfortable nursing him there, so instead I distracted him until we got home, where he could nurse in private. I am not proud of the fact that I denied my child the one thing that would have consoled him more than anything in that moment. In fact, I'm ashamed that I did not have the strength of character to breastfeed my walking, talking toddler regardless of what others might have thought. Possibly, I was more self-conscious than usual because my husband and I had moved to the quiet suburban community of Upton, Massachusetts, USA the previous year and we still felt a little bit like misfits.

Throughout my life I've often been unconventional in my thoughts and actions, so one would think when it came to the well-being of my child I'd be able to endure a few looks or comments sent my way. I had my reasons for not nursing my toddler at that moment in time, the most obvious one being that I had no role models in my immediate or extended family who nursed beyond a year (let alone three months), and very few in my circle of friends. I used to view toddler nursing a lot differently than I do now.

Ten years ago, I was in school preparing for my current profession as a massage therapist. There was a student in my class named Lisa who was a mother of two children, one a toddler, the other a preschooler. Lisa was talking to me and another student about how she was breastfeeding both of her children, and how much she loved it. I was ignorant on the subject of breastfeeding and didn't think much of her comments until after Lisa walked away and the other student to whom she'd also been talking with said, "There's something seriously wrong with her. She must be deranged. Once a child can walk and talk, nursing is perverse." That comment left a strong impression on me and, unfortunately, from that time on I thought Lisa was a little off, maybe even mentally ill.

Fast forward to today: I'm nursing my two-year-old son with no plans to wean in the near future. When Jarrett was born, I definitely thought he would be weaned before he was a toddler, but the path of motherhood can take a woman to unexpected places. When I realized that Jarrett would still be nursing well past his first birthday, I began to read every book I could get my hands on to help me figure out my way.

Why nurse beyond a year?

Quite simply: breast is best. A disservice is done to all when people are misled to believe that formula comes close to the quality of human milk.

Although most doctors avoid saying so, out of fear of alienating some clients, formula-fed babies are generally less healthy than breastfed babies. The cognitive development of babies fed formula doesn't equal that of those who are breastfed. Breast milk protects against disease and promotes optimal brain growth. Formula does neither of these things. (Huggins 2007)

Manufacturers are unable to duplicate human milk and they continually experiment. As further explained by Kathleen Huggins in A Nursing Mothers Guide to Weaning, some have even called "the mass feeding of artificial human milk...one of the greatest experiments ever undertaken on human beings."

Many people are familiar with the recommendation that, to achieve optimal growth, infants should be exclusively breastfed for the first six months of life. What some don't realize, however, is that there are benefits to nursing a child beyond six months. The World Health Organization (WHO) recommends nursing for a minimum of two years, and the United Nations Children's Fund (UNICEF) advises the same. The American Academy of Pediatrics (AAP) recommends breastfeeding for at least a year.

Even after 12 months, babies continue to benefit from human milk. At one year of age, a baby's immune system is functioning at only 60 percent of adult level and because formula has no live antibodies, it is strongly associated with high rates of infection (Huggins 2007). A child's immune system isn't functioning at adult level until age six (Dettwyler 1994).

The benefits of breastfeeding make it the optimal feeding choice. Also, there is no easier way to comfort a sick or upset child than to simply breastfeed. According to Norma Jane Bumgarner in MOTHERING YOUR NURSING TODDLER:

Sucking is a necessary restorative for rapidly growing little people, so much so that most children who do not nurse seek an alternative such as a bottle, pacifier, thumb, fingers, hair, or blanket. Sucking on these alternatives can force a child's permanent teeth out of alignment, while nursing actually improves the dental arch and may minimize self-comforting techniques.

In addition, the benefits of breastfeeding a baby extends to a toddler for as long as a mother nurses. For an ill toddler, the ability to keep him hydrated and happy is a definite boon. Offering comfort is such a fundamental part and advantage of nursing a toddler -- an aspect of the nursing relationship that is seldom understood by those who haven't done it.

Why isn't nursing into toddler-hood "the norm" in some societies?

Examining the animal kingdom indicates that extended breastfeeding is a natural function. In Katherine Dettwyler's article, "A Time to Wean," she discusses weaning habits of mammals, especially those of primates. She looks at a number of factors that may influence the age of weaning for these primates (quadrupling of birth weight, attainment of one-third adult weight, gestation length, and dental eruption) and evaluates what the human equivalent would be for weaning according to these factors. For example, for humankind's closest relatives, the chimpanzee and the gorilla, the duration of breastfeeding is six times the length of gestation. "Based on these comparisons, an estimated natural age at weaning for humans would be a minimum of six times gestational length, or four-and-a-half years" (Dettwyler 1995). Another thing that was considered in her study was the fact that many primates wean their offspring when their permanent molars come in, which for humans occurs around five and a half or six years of age. Adult immune competence for humans occurs around six years old, "suggesting that throughout our recent evolutionary past, the active immunities provided by breast milk were normally available to the child until about this age." Dettwyler ultimately concludes:

Non human primate data suggest that human children are designed to receive all the benefits of breast milk and breastfeeding for an absolute minimum of two and a half years, and an apparent upper limit of around seven years.

Human history supports Dettwyler's studies. Nursing into toddlerhood was a common, natural occurrence. Soranus and Galen, for example, were two Roman doctors who wrote what was to remain the standard Western reference on infant care until the 18th century. Galen believed complete weaning shouldn't occur until the child turned three, and Soranus said not until a child had all his baby teeth should he be weaned (Huggins 2007). Clearly if extended breastfeeding was harmful, it would have negatively impacted the human race. "Any serious harmful effects of long-term nursing would have crippled the entire ancient world" (Bumgarner 2000).

In the early part of the 20th century, an anthropological study was conducted looking at childrearing practices in 52 societies. It was found that only two weaned their children before the age of one year. The US middle class limited infant feeding more strictly and stopped breastfeeding earlier than all but one other society (Huggins 2007).

In a study done of 64 primitive cultures in 1945, it was found that only one culture weaned their children as young as six months. Mothers in China and Japan still nursed their children for four or five years well into the 20th century. During World War II, Burmese children nursed until age three or four. Up until 1950 in Kenya, mothers nursed until five, and in Mongolia mothers nursed until two or three and sometimes as old as six and seven. In New Guinea during the 1960s, children were nursing freely up until two, three, and sometimes four years of age (Bumgarner 2000).

Breastfeeding into toddlerhood is natural and beneficial, but how common is it across the world today? As explained in A Nursing Mother's Guide to Weaning, Margaret Mead and other anthropologists discovered that mothers wean in the way and at the time that their cultures prescribe and that peaceful, cooperative societies tend to wean later using gentler methods. Furthermore, it has been estimated the median age of weaning throughout the world is between ages three and five. That's years, not months.

Through Norma Jane Bumgarner's exploration of traditional cultures in the modern world, an interesting picture is painted. The Siriono people of Bolivia don't wean before the age of three. In Mexico, the Zinacanteco Indians (descendants of Mayans) nurse until age four or five. In East Africa and the Philippines, nursing for several years is not rare.

So, how did some cultures stray so dramatically from the practice of extended breastfeeding? As Dettwyler states, breastfeeding is both a biological process and a culturized activity.

As a biological process it [breastfeeding] is firmly grounded in our mammalian ancestry....as a heavily culturized activity, it is modified by a wide variety of beliefs, not only about infant health and nutrition, but also about the nature of human infancy and the proper relationships between mother and child, and between mother and father.

As ideals, expectations, and family roles shift, so does the culture. Other issues that can affect breastfeeding and weaning include religious beliefs, a mother's every day activities and employment, and ideas about independence and autonomy.

What about the myths?

A mom who decides to nurse a toddler in a culture that doesn't understand the benefits can be the recipient of unintended hurtful comments. Here is an exploration of popular myths that many moms are faced with.

"If a child can ask to nurse, there's something wrong with doing so." Interestingly enough, it's deemed appropriate to hug and cuddle children, while nursing -- something that is also an act of love and affection -- is seen as inappropriate past a certain age. Giving children bottles, which were designed to imitate the breast, is also acceptable. As stated in The Nursing Mother's Companion:

Many toddlers are dependent on a bottle, pacifier, thumb, or blanket, and this is quite accepted, but a mother who is nursing a toddler may have to deal with veiled or point-blank suggestions that her child is too old for it.

Why is this? It is indicative of a culture that has made the human female breast solely into a sexual object instead of its primary and original role as an organ that supplies nourishment. There exist some cultures where the sight of a female breast in public does not turn heads or raise eyebrows. It is just another body part. In cultures where the breast has been sexualized, many become uncomfortable seeing a nursing child who is over one year old.

In the US, the image of a bottle is largely associated with the birth of a new baby and standard feeding practices. This sets the backdrop for a culture that judges those who practice extended breastfeeding. As Stephanie Ondrack points out in her article, "Taking Down the Almighty Bottle," from advertisements in magazines, to mothering icons on the doors of changing rooms, to gift cards and wrapping paper, images of bottle-feeding far outweigh images of breastfeeding. She also describes her experiences of teaching breastfeeding classes to new, expectant parents where they often begin holding the doll with its body and head facing the sky as opposed to the mother's chest. "The bottle-feeding position has become the default definition of feeding position." A woman who has breastfed knows that just turning her baby's head toward her chest does not work -- baby's entire body has to be facing her chest (when using the cradle position), or breastfeeding just doesn't work.

"Once a child no longer needs mother's milk solely for nutritional purposes, there's no sense in breastfeeding." In truth, a mother's milk is just as nutritious and continues to provide immunities to a toddler while being a source of comfort.

We seem to believe that the only legitimate excuse for breastfeeding is hunger and that anything else is a misuse of the goods...we see the need for comfort as not only inferior to the need for food, but as requiring suppression. (Ondrack 2006)

"After a certain point, the nursing relationship is more for the mother than the child." There's no denying that breastfeeding provides emotional and physical benefits to a mother as well as a child. However, if there weren't anything in the relationship for the child (comfort, nourishment), he simply wouldn't nurse.

No matter how evil some people may make mother's enjoyment sound, a woman's enjoyment of breastfeeding is a good thing -- one of the many wholesome pleasures available in life. (Bumgarner 2000)

And conversely, if a mother thinks she might stop nursing her toddler for whatever reason, her feelings need to be factored into whatever decision is made about weaning. Bumgarner explains, "To continue to nurse an older baby and hate it tends to become martyrdom -- a poor basis for any family relationship."

"Extended nursing will spoil a child," also known as, "He'll nurse until he goes off to college." This myth touches on peoples' fears that nursing into toddlerhood spoils children and doesn't teach them independence. In reality, it's not breastfeeding, which meets many needs, that spoils a child -- rather, it's the absence of teaching acceptable behavior that causes a child to "spoil." Bumgarner comments:

It is without closeness and loving, and without sufficient attention to the business of teaching good behavior that children are spoiled...things which are spoiled are things which have been left on the shelf to rot.

It's interesting to note that parents can't force a child to crawl, walk, or talk before they're ready, and yet they're encouraged by professionals and others to impose early weaning on these same children without recognizing it as one of the more significant events of their lives. "Few of us understand weaning as the great and dangerous passage it is known to be in most of the world's societies. But when we ignore the dangers and difficulties of weaning, we risk our children's well-being and sometimes our own" (Huggins 2007).

Dr. William Sears, who wrote The Baby Book, states:

We have studied the long-term effects on thousands of children who had timely weanings and have observed that these children are more independent, gravitate to people more than things, are easier to discipline, experience less anger, radiate trust...[after] studying the long-term effects of long-term breastfeeding, the most secure... and happy children we have seen are those who have not been weaned before their time.

Encouraging autonomy and teaching children how to be independent is a very important life lesson. It is the role of parents to teach a child the skills he needs to care for himself, whether that be cooking, laundry, or changing a spare tire. As Huggins (2007) writes:

It is not our job as parents simply to take care of children, but to help them learn how to take care of themselves. So, rather than fretting over toilet training or weaning in the toddler years -- these things which will take care of themselves -- it is more constructive to help children learn to do the things they want and need to do.

Conclusion

As for my son, Jarrett, he won't be going to the store on his own or changing tires in the near future. He'll continue to be my nursing toddler. Right now, I'm trying not to be that mom on the playground last year who was fretting over what others might think about me breastfeeding my toddler. Instead, I'm being the mom who remains focused on the task at hand, whether it is nursing my son in a time of crisis or raising him to be a decent human being.

"Despite the evidence that breastfeeding beyond a year is in a child's best interest, passionate opinions can be found on both sides of the topic. Regardless of what scientific studies, health professionals, and history say about the benefits of extended breastfeeding, a mother may encounter comments and suggestions from family and friends that will make her second guess her parenting choices. Finding reliable information, support, and a positive role model can make all the difference in the world to a mom who doubts herself. I speak from personal experience. A lot of reading and one courageous woman at a La Leche League meeting inspired me to continue breastfeeding my son into toddlerhood after seeing her twins stand up and nurse simultaneously." -- Jen Davis

In her book, HOW WEANING HAPPENS, author Diane Bengson offers suggestions and insights into the different needs of nursing toddlers.

Remember, breastfeeding past the age of one often takes on a different character (than nursing a younger baby). Toddlers have many reasons to nurse. One reason is that they enjoy the familiar taste of their mother's milk when they're hungry. One-year-olds also find that mother's breast is a safe haven, a place to return to after a toddler-sized "adventure." They use breastfeeding for comfort and closeness and may often view nursing as the most enjoyable way to be with mother, especially after separations.

Pressure to wean can come from people in your extended family who may be genuinely concerned that your child will come to harm if you don't wean immediately. If you are being pressured to wean due to fears or biases your family holds, you may want to educate them about extended nursing. Give them information in small batches, respectfully, and give them a chance to respond. Don't worry if you don't have all the answers, or can't match all of their arguments. Some mothers have found it better to say very little, or simply say, "This is what I plan to do. I'd like your support." One tactic that can help put an end to a power struggle is to admit you don't have all the answers and that there is more than one way to parent.

Friends and neighbors may also pressure you to wean, or at least offer unsolicited advice. These people in your life don't need to know you are still nursing. You don't have to feel dishonest if you don't reveal all the details of your life to friends and acquaintances. Good friends who care about you will usually be glad to hear why you have made the decision to continue to nurse. Some friends, if they have made different mothering choices than you, may feel uncomfortable or threatened. Learning to de-emphasize your differences and not make comparisons can help you preserve and enjoy your friendship.

"Nursing makes the job of mothering easier, not harder."

Norma Jean Bumgarner, author of MOTHERING YOUR NURSING TODDLER

When the baby does not wean by a year or so, a mother may wonder if this means he is too dependent on her. She may fear that letting him continue to nurse will prevent him from growing toward independence. But weaning is a step toward growing up and, like walking or talking, a child takes these steps according to his own timetable. All children stop nursing sooner or later. Some have the need to continue the nursing relationship longer than others -- but they do grow out of it eventually. And still they do not become overly dependent. We have been reassured on this point many times over because we have observed firsthand hundreds of babies who were considered "late weaners." Independence, not dependence, is one outstanding trait they seem to have in common as they grow up.

Keep in mind that all children wean eventually....Nursing a toddler is not something you strive for, but it is part of a very special relationship between mother and child.

If at all possible, you'll want to take your time with weaning and proceed slowly. We talk about weaning as something to be done "gradually and with love." You'll need to step up the loving attention you give your baby in other ways during the time that you cut back on nursing him.

If your toddler continues to enjoy nursing, you may find there are many advantages that continue to go along with toddler nursing. It is so easy to help an overtired or fussy child calm down and often fall asleep through nursing. If he hurts himself there is no better way to soothe him. Because nursing eases frustration, many families find that it helps turn the "terrible twos" into the "terrific twos," minimizing the usual competitive behavior of the two-year-old. Sometimes behavior that is normal for a toddler is blamed on breastfeeding if the child is still nursing. Behavior such as clinging and demanding normally occurs at this age, whether the child has weaned or not.

Sometimes a mother needs to evaluate the nursing relationship she has with her toddler and consider whether things are really going well. In some situations, nursing can become the easy way out, substituting for other kinds of attention the toddler really needs.